Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Department of Orthopedic Surgery, Royal Children's Hospital, Melbourne, Australia.
Am J Sports Med. 2020 Mar;48(4):966-973. doi: 10.1177/0363546520902475. Epub 2020 Feb 13.
Autologous osteochondral grafting (OG) is an option in the treatment of capitellar osteochondritis dissecans (COCD). However, radiographic healing after this procedure has not been well documented.
To develop a magnetic resonance imaging (MRI)-based scoring system specific for evaluating healing after single-plug OG in COCD and to evaluate correlation between radiographic healing and early clinical outcomes.
Cohort study (diagnosis); Level of evidence, 3.
Between 2014 and 2017, 183 elbows with COCD were enrolled in a prospective registry. A total of 61 elbows in 59 patients underwent single-plug OG. Of these, 52 elbows in 50 patients had pre- and postoperative MRI scans. Postoperative MRI and clinical outcome data from this group were used to develop the novel BOGIE score (Boston Osteochondral Graft Incorporation in the Elbow), with a possible range of 4 to 12.
Median age at surgery was 14.2 years (interquartile range, 13.1-15.0 years). Median clinical follow-up after OG was 12.4 months (interquartile range, 9.5-16.9 months; range, 6-53 months). Compared with before surgery, elbow function at 6 months after surgery and at latest follow-up was significantly improved as measured by the Timmerman and Andrews score (TAS; median: 145 before surgery, 185 at 6 months after surgery, 190 at latest follow-up; < .001, before vs after surgery), as well as the short version of Disabilities of the Arm, Shoulder and Hand score; median: 21 before surgery, 7 at 6 months after surgery, and 0 at latest follow-up; < .001 before surgery vs after surgery). Median BOGIE score at 6 months after surgery was 10 (range, 4-12). BOGIE score intraobserver reliability was 0.90 (95% CI, 0.82-0.94) for reader 1 and 0.91 (95% CI, 0.86-0.95) for reader 2. Interobserver reliability between the readers was 0.86 (95% CI, 0.78-0.92). Correlation was observed between the 6-month BOGIE score and the concurrent postoperative objective TAS ( < .001) as well as total TAS ( = .01) but not the subjective TAS ( = .08). Patients who underwent subsequent secondary surgery for persistent symptoms had a significantly lower postoperative BOGIE score at 6 months than those who did not (median, 7.8 vs 10.3; = .016).
Quantitative evaluation for radiologic healing after single-plug OG in COCD is possible. The MRI-based BOGIE score appears to correlate with early clinical function and may be useful as an adjunct tool in decision making on activity progression. The use of a standardized MRI score may improve comparability of outcomes after OG in the literature.
自体骨软骨移植（OG）是治疗肱骨小头剥脱性骨软骨炎（COCD）的一种选择。然而，该手术的影像学愈合情况尚未得到充分记录。
开发一种基于磁共振成像（MRI）的评分系统，专门用于评估 COCD 中单栓 OG 后的愈合情况，并评估影像学愈合与早期临床结果之间的相关性。
队列研究（诊断）；证据水平，3 级。
2014 年至 2017 年，前瞻性注册登记了 183 例 COCD 肘部。共有 61 例 59 例患者接受了单栓 OG。其中，52 例 50 例患者在术前和术后均进行了 MRI 扫描。使用该组的术后 MRI 和临床结果数据开发了新的 BOGIE 评分（波士顿肘骨软骨移植融合），评分为 4 到 12 分。
手术时的中位年龄为 14.2 岁（四分位距，13.1-15.0 岁）。OG 后中位临床随访时间为 12.4 个月（四分位距，9.5-16.9 个月；范围 6-53 个月）。与术前相比，术后 6 个月和末次随访时的肘部功能通过 Timmerman 和 Andrews 评分（TAS；中位数：术前 145，术后 6 个月 185，末次随访 190；<0.001，术前 vs 术后）以及手臂、肩部和手残疾简易评分（中位数：术前 21，术后 6 个月 7，末次随访 0；<0.001，术前 vs 术后）均明显改善。术后 6 个月时 BOGIE 评分为 10 分（范围，4-12 分）。读者 1 的 BOGIE 评分的观察者内可靠性为 0.90（95%CI，0.82-0.94），读者 2 的观察者内可靠性为 0.91（95%CI，0.86-0.95）。两位观察者之间的观察者间可靠性为 0.86（95%CI，0.78-0.92）。6 个月时 BOGIE 评分与同期术后客观 TAS（<0.001）和总 TAS（=0.01）均存在相关性，但与主观 TAS（=0.08）无相关性。因持续性症状而接受后续二次手术的患者术后 6 个月的 BOGIE 评分明显低于未接受二次手术的患者（中位数，7.8 比 10.3；=0.016）。
对 COCD 中单栓 OG 后影像学愈合情况进行定量评估是可行的。基于 MRI 的 BOGIE 评分似乎与早期临床功能相关，可作为决定活动进展的辅助工具。使用标准化的 MRI 评分可能会提高文献中 OG 后结果的可比性。
